Provider Demographics
NPI:1427062256
Name:CAMMACKS PHARMACIES INC
Entity type:Organization
Organization Name:CAMMACKS PHARMACIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:CAMMACK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:360-452-4200
Mailing Address - Street 1:424 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-3119
Mailing Address - Country:US
Mailing Address - Phone:360-452-4200
Mailing Address - Fax:360-457-6557
Practice Address - Street 1:424 E 2ND ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3119
Practice Address - Country:US
Practice Address - Phone:360-452-4200
Practice Address - Fax:360-457-6557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA9030552332B00000X
WACF000579633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6148704Medicaid
WA9012352Medicaid
WAG8890408OtherMEDICARE FLU PTAN
WA9012345Medicaid
WA9030552Medicaid
WA0250020001Medicare NSC
WA1427062256Medicare NSC